1184343402 NPI number — MRS. TAMARIE MAURENE STEEN LMHC

Table of content: MRS. TAMARIE MAURENE STEEN LMHC (NPI 1184343402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184343402 NPI number — MRS. TAMARIE MAURENE STEEN LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEEN
Provider First Name:
TAMARIE
Provider Middle Name:
MAURENE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRADLEY-SULLIVAN
Provider Other First Name:
TAMARIE
Provider Other Middle Name:
MAURENE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMHC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184343402
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 480645
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28269-5305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-262-8178
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1011 SKIPJACK LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28269-4899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-262-8178
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH16721 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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